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Thurs. Feb. 17, 2011 — Posting calorie information does not appear to have any effect on what children and adolescents choose to eat at fast-food restaurants, a small study suggests.

For example, a survey of NY teens found that even though 57 percent said they noticed the calories on the menu, only 9 percent said they considered that information when ordering — and only 9 percent reported purchasing items with fewer calories.

New York health officials were among the first to require fast food restaurants to include calorie information on menus — the city regulation went into effect in July 2008, so Dr. Brian Elbel, of the New York University School of Medicine, and colleagues decided to test the law’s impact on kids and teens in the Big Apple.

Both before and after the policy change, the average number of calories purchased was 645, the researchers reported online in the International Journal of Obesity.

Although the sample size of the study — 349 children and teens — was too small to detect slight changes in calories purchased, Elbel and his colleagues wrote, "small effects from labeling alone are not likely to influence obesity in a meaningful way, unless combined with other policy approaches to further contribute to a reduction in calories."

Fast-food consumption has been implicated in the growing problem of obesity in the U.S., and mandatory calorie labeling in restaurants has been proposed as one way to help people make healthier food choices.

New York City was the first city to implement a calorie-posting requirement in chain restaurants. Now, mandatory calorie labeling is mandated nationally by the Affordable Care Act. The law requires restaurants with 20 or more locations nationwide to post caloric content either on menu boards or printed menus.

To evaluate the potential effect of such a policy, Elbel and his colleagues collected information on children's and adolescents' fast-food choices in low-income neighborhoods in New York City and Newark, N.J. The latter city did not have a calorie-labeling requirement during the study period.

The study focused on low-income, racially and ethnically diverse populations because they are hit harder by obesity. The researchers collected information from customers at five restaurants in Newark and 14 in New York City, all from the following four fast-food chains: McDonald's, Burger King, Wendy's, and Kentucky Fried Chicken (KFC).

During two-week periods both before and after implementation of calorie labeling law, the researchers approached customers as they entered the restaurant and offered them $2 to bring back their food receipts and answer a set of questions.

Customers ages 13 to 17 answered for themselves, and parents or caregivers responded for younger participants; 31 percent of participants were in the restaurant without adult supervision.

The introduction of calorie labeling in New York City was not associated with a change in the number of calories purchased in either study city for any age group.

Although the dissemination of more accurate calorie information on menus is a supposed benefit of calorie labeling, the researchers noted, about 60 percent of adolescents dramatically underestimated the calorie content of their food — by an average of 466 to 494 calories.

A similar proportion also underestimated the number of daily calories needed for an adult to maintain a normal weight — saying that less than 1,500 was sufficient.

"If they truly believe that the daily caloric intake should be less than it actually is, then greater knowledge surrounding the proper amount of calories could give license for greater consumption of calories," Elbel and his colleagues wrote.

The group acknowledged some limitations of their study, including the short study period and the potential influence of inconsistencies in the format of how calorie information was presented.

The study received funding from the Robert Wood Johnson Foundation Healthy Eating Research program, the Yale Rudd Center for Food Policy and Obesity, the NYU Wagner Dean's Fund and the National Heart, Lung, and Blood Institute.